Costa Marcos, Braga Vinícius Lopes, Yağmurlu Kaan, Centeno Ricardo Silva, Cavalheiro Sérgio, Chaddad-Neto Feres
Federal University of Sao Paulo, Department of Neurosurgery, Sao Paulo, Brazil.
Turk Neurosurg. 2018;28(6):934-939. doi: 10.5137/1019-5149.JTN.20884-17.1.
Dissection of white fibers is important in identifying detailed neuroanatomical relationships. With tractrography it is possible to transport and apply this knowledge in a practical way to treat many diseases involving the white matter.
The Klingler method, subsequently disseminated by Türe with slight modifications was used.
We review some historical aspects of white fibers and provide a guide for dissection of the internal capsule. The removal of gray matter allowed us to obtain a view of the white matter. We removed all U-shaped fibers to expose the insular cortex. The cortex of the insular lobe was removed, which exposed the extreme capsule. The removal of the claustrum exposed the external capsule, which covers the lentiform nucleus, specifically the putamen. During dissection, removing some fibers of the external capsule produced windows in which the putamen could be medially visualized. Since the internal capsule lies medial to the lentiform nucleus, it was necessary to remove the nucleus in order to expose the internal capsule. We identified five regions of the internal capsule: the anterior limb, genu, posterior limb, and sublenticular and retrolenticular parts. Finally, we determined that the fibers of the corona radiata condense into the internal capsule at the level of the superior border of the lentiform nucleus.
Knowledge gained with the cadaveric fiber dissection technique can be applied in microsurgical practice and can be used to evaluate the surgical treatment for different tumors and vascular malformations.
白质纤维解剖对于识别详细的神经解剖关系很重要。通过纤维束成像，可以将这一知识以实际的方式用于治疗许多涉及白质的疾病。
采用了随后由图雷稍加修改后传播的克林格勒方法。
我们回顾了白质纤维的一些历史方面，并提供了内囊解剖的指南。去除灰质使我们能够看到白质。我们去除了所有U形纤维以暴露岛叶皮质。去除岛叶皮质后，暴露了外囊。去除屏状核后，暴露了覆盖豆状核（特别是壳核）的外囊。在解剖过程中，去除外囊的一些纤维形成了可以从内侧看到壳核的窗口。由于内囊位于豆状核的内侧，因此有必要去除该核以暴露内囊。我们确定了内囊的五个区域：前肢、膝部、后肢以及豆状核下和豆状核后部。最后，我们确定放射冠纤维在豆状核上缘水平汇聚成内囊。
尸体纤维解剖技术所获得的知识可应用于显微外科实践，并可用于评估不同肿瘤和血管畸形的手术治疗。
